Surgical instruments

ABSTRACT

Articulation joints for use in connection with a surgical instrument that has a portion that must be passed through a trocar or similar structure and then articulated relative to another portion of the instrument received within the trocar. Various embodiments of the articulation joint include at least one flexible driven member to articulate the surgical implement relative to the handle assembly of the instrument.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional patent application claiming priorityunder 35 U.S.C. § 121 to U.S. patent application Ser. No. 16/041,191,entitled SURGICAL INSTRUMENTS, filed Jul. 20, 2018, now U.S. PatentApplication Publication No. 2019/0015096, which is a continuationapplication claiming priority under 35 U.S.C. § 120 to U.S. patentapplication Ser. No. 14/679,441, entitled SURGICAL INSTRUMENTS, filedApr. 6, 2015, which issued on Jul. 24, 2018 as U.S. Pat. No. 10,028,742,which is a continuation application claiming priority under 35 U.S.C. §120 to U.S. patent application Ser. No. 14/506,929, entitled ENDEFFECTORS FOR SURGICAL STAPLERS, filed Oct. 6, 2014, which issued onFeb. 20, 2018 as U.S. Pat. No. 9,895,147, which is a continuationapplication claiming priority under 35 U.S.C. § 120 to U.S. patentapplication Ser. No. 12/731,347, entitled HYDRAULICALLY AND ELECTRICALLYACTUATED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS, filed Mar. 25,2010, which issued on Oct. 14, 2014 as U.S. Pat. No. 8,858,571, which isa divisional patent application claiming priority under 35 U.S.C. § 121to U.S. patent application Ser. No. 11/270,866, entitled HYDRAULICALLYAND ELECTRICALLY ACTUATED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS,filed Nov. 9, 2005, now U.S. Patent Application Publication No.2007/0106317, the entire disclosures of which are hereby incorporated byreference herein.

BACKGROUND OF THE INVENTION

Endoscopic surgical instruments are often preferred over traditionalopen surgical devices since a smaller incision tends to reduce thepost-operative recovery time and complications. Generally, theseendoscopic surgical instruments include an “end effector”, a handleassembly and a long shaft that extends between the end effector and thehandle assembly. The end effector is the portion of the instrumentconfigured to engage the tissue in various ways to achieve a desireddiagnostic or therapeutic effect (e.g., endocutter, grasper, cutter,staplers, clip applier, access device, drug/gene therapy deliverydevice, and energy device using ultrasound, RF, laser, etc.). The endeffector and the shaft portion are sized to be inserted through a trocarplaced into the patient. The elongated shaft portion enables the endeffector to be inserted to a desired depth and also facilitates somerotation of the end effector to position it within the patient. Withjudicious placement of the trocar and use of graspers, for instance,through another trocar, often this amount of positioning is sufficient.Surgical stapling and severing instruments, such as those described inU.S. Pat. No. 5,465,895, are an example of an endoscopic surgicalinstrument that successfully positions an end effector by insertion androtation.

BRIEF DESCRIPTION OF THE FIGURES

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention,and, together with the general description of the invention given above,and the detailed description of the embodiments given below, serve toexplain various principles of the various embodiments of the presentinvention.

FIG. 1 is a partial perspective view of one non-limiting embodiment of amoment arm extension arrangement employed in connection with ahydraulically operated endocutter with the tube segments thereof in afirst substantially coaxially aligned position;

FIG. 2 is another perspective view of the moment arm extensionarrangement and endocutter of FIG. 1 with the tube segments articulatedat an angle relative to each other;

FIG. 3 is a partial cross-sectional view of an end effector employed inthe endocutter depicted in FIGS. 1 and 2 with the anvil thereof in anopen or unclamped position with some of the elements thereof omitted forclarity;

FIG. 4 is another cross-sectional view of the end effector of FIG. 3 ina closed or clamped position with the cutting bar in an extendedposition;

FIG. 5 is another cross-sectional view of the end effector of FIGS. 3and 4 showing tissue after being cut and stapled therein;

FIG. 6 is an exploded perspective view of the end effector depicted inFIGS. 1-5;

FIG. 7 is another exploded assembly view of the end effector and astaple cartridge;

FIG. 8 is a plan view of a staple cartridge installed in an end effectordepicted in FIGS. 6 and 7;

FIG. 9 is a cross-sectional end view illustrating the end effectorinserted into a trocar passageway;

FIG. 10 is a perspective view of a cartridge installed in an endeffector with the anvil thereof in an open or unclamped position;

FIG. 11 is a schematic depiction of one hydraulic system embodiment ofthe present invention;

FIG. 12 is a partial perspective view of one non-limiting embodiment ofan articulation joint of the present invention in an articulatedposition;

FIG. 13 is another partial perspective view of the articulation jointdepicted in FIG. 12 in an articulated position;

FIG. 14 is another partial perspective view of the articulation jointembodiment depicted in FIGS. 12 and 13 in an articulated position;

FIG. 15 is a partial cross-sectional view of another non-limitingembodiment of an articulation joint of the present invention in anarticulated position;

FIG. 15A is a partial cross-sectional view of another articulation jointof the present invention in an articulated position;

FIG. 16 is a partial cross-sectional view of another articulation jointof the present invention in an articulated position;

FIG. 16A is a partial cross-sectional view of another articulation jointof the present invention in an articulated position;

FIG. 17 is a partial cross-sectional view of another articulation jointembodiment of the present invention in an articulated position;

FIG. 17A is a partial cross-sectional view another articulation joint ofthe present invention in an articulated position;

FIG. 18 depicts a partially cut-away side elevation view of a surgicalinstrument in an open position according to various embodiments of thepresent invention;

FIG. 19 depicts a cross-sectional side elevation detail view along theline 19-19 of FIG. 18 of an end effector of the surgical instrument inan up or open position according to various embodiments of the presentinvention;

FIG. 20 depicts a cross-sectional side elevation detail view along theline 19-19 of FIG. 18 of an end effector of the surgical instrument in adown or closed position according to various embodiments of the presentinvention;

FIG. 21 depicts a three dimensional view of the end effector at thedistal end of the surgical stapling and severing instrument of FIG. 18with the anvil in the up or open position and portions of the cartridgelargely removed exposing exemplary staple drivers and an exemplarycutting edge according to various embodiments of the present invention;

FIG. 22 depicts a three dimensional view of an end effector at thedistal end of the surgical stapling and severing instrument of FIG. 18with the anvil in the up or open position exposing the staple cartridgeand cutting according to various embodiments of the present invention;

FIG. 23 depicts a two dimensional top-down view of an elongate channelof the surgical stapling and severing instrument of FIG. 18 according tovarious embodiments of the present invention;

FIG. 24 depicts a two dimensional top-down view of a staple cartridgeinstalled in an elongate channel with a portion of the staple cartridgeremoved to show exemplary staple drivers according to variousembodiments of the present invention;

FIG. 25 depicts a three dimensional view of the elongate channel of thesurgical stapling instrument of FIG. 18 showing a staple cartridgeaccording to various embodiments of the present invention;

FIG. 26 depicts a section view showing the cross-sectional relationshipbetween the hydraulic bladders according to various embodiments of thepresent invention;

FIG. 27 depicts a three dimensional, exploded view of the implementportion of the surgical stapling and severing instrument of FIG. 18according to various embodiments of the present invention;

FIG. 28 depicts an un-inflated hydraulic bladder staple driver for usein a surgical instrument according to various embodiments of the presentinvention;

FIG. 29 depicts an inflated hydraulic bladder staple driver for use in asurgical instrument according to various embodiments of the presentinvention;

FIG. 30 depicts a hydraulic cylinder staple driver for use in a surgicalinstrument according to various embodiments of the present invention;

FIG. 31 depicts a hydraulic staple driving assembly for use in asurgical instrument according to various embodiments of the presentinvention;

FIG. 32 depicts a side view of a hydraulic staple driving assembly foruse in a surgical instrument according to various embodiments of thepresent invention;

FIG. 33 depicts a top view of a hydraulic staple driving assembly foruse in a surgical instrument according to various embodiments of thepresent invention;

FIG. 34 depicts a side view of a hydraulic staple driving assembly foruse in a surgical instrument according to various embodiments of thepresent invention;

FIG. 35 depicts the distal end of a surgical stapling and severinginstrument having an articulating end effector shown in the down orclosed position according to various embodiments of the presentinvention;

FIG. 36 depicts a three dimensional view of a hydraulic surgicalinstrument according to various embodiments of the present invention;

FIG. 36A depicts a schematic diagram of a hydraulic system for use in asurgical instrument according to various embodiments of the presentinvention;

FIG. 37 depicts a side elevation view in centerline section of thesurgical stapling and severing instrument of FIG. 18 with the endeffector in a partially closed but unclamped position gripping tissueaccording to various embodiments of the present invention;

FIG. 38 depicts a partially cut-away side elevational view of thesurgical stapling and severing instrument of FIG. 18 in the closed orclamped position according to various embodiments of the presentinvention;

FIG. 39 depicts a side elevation view in centerline section of thedistal end of the surgical stapling and severing instrument of FIG. 18in the closed or clamped position with tissue properly compressedaccording to various embodiments of the present invention;

FIG. 40 depicts a partially cut-away side elevation view of the surgicalstapling and severing instrument of FIG. 18 in a partially firedposition according to various embodiments of the present invention;

FIG. 41 depicts a side elevation view in centerline section of thedistal end of the surgical stapling and severing instrument of FIG. 18in a partially fired position according to various embodiments of thepresent invention;

FIG. 42 depicts a partially cut-away side elevation view of the surgicalstapling and severing instrument of FIG. 18 in a fully fired positionaccording to various embodiments of the present invention; and

FIG. 43 depicts a side elevation view in centerline section of thedistal end of the surgical stapling and severing instrument of FIG. 18in a fully fired position according to various embodiments of thepresent invention.

DETAILED DESCRIPTION OF THE INVENTION

Turning to the Figures, wherein like numerals denote like componentsthroughout the several views, FIGS. 1 and 2 depict one embodiment of asurgical instrument 10 that is capable of practicing the unique benefitsof the present invention. As can be seen in FIGS. 1 and 2, theinstrument 10 includes a handle assembly 200 and a surgical implementportion 12. As used herein, the term “surgical implement” refers to acomponent or set of components configured to engage tissue to accomplisha surgical task. Examples of surgical implements include, but are notlimited to: endocutters, graspers, clamps, cutters, staplers, clipappliers, probes or access devices, drug/gene therapy delivery devices,energy devices such as ultrasound, RF, or laser devices, etc.

In the non-limiting embodiment depicted in the Figures, the surgicalinstrument 10 includes a hydraulically actuated end effector 22 andhandle arrangement 200 of the type disclosed in the U.S. patentapplication Ser. No. 11/270,217, entitled SURGICAL INSTRUMENT HAVING AHYDRAULICALLY ACTUATED END EFFECTOR, now U.S. Pat. No. 7,799,039, thatwas filed on Nov. 9, 2005 and which is commonly owned with the presentapplication and which the disclosure thereof is hereby incorporated byreference in its entirety. As the present Detailed Description proceeds,however, the skilled artisan will readily appreciate that the unique andnovel features of the various embodiments of the present invention mayalso be employed in connection with electrically actuated orpneumatically actuated end effectors. Thus, the various embodiments ofthe present invention may be advantageously employed in connection witha variety of surgical implements other than the exemplary embodimentdepicted in the Figures without departing from the spirit and scope ofthe present invention. Accordingly, the scope of protection afforded tothe various embodiments of the present invention should not be limitedto use only with the specific type of surgical implements specificallydescribed herein.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

FIGS. 3-10 show views of one type of end effector 22 configured toperform clamping, severing and stapling of tissue according to variousembodiments the present invention. In one embodiment, the end effector22 has a body portion 24 that is provided with an elongate channel 26for receiving a staple cartridge 60 therein. An anvil 28 is coupled tothe body portion 24 and is capable of being selectively pivoted towardand away from cartridge 60 mounted in the elongate channel 26. FIGS. 3and 10 illustrate the anvil 28 in an open position and FIGS. 4 and 5illustrate the anvil 28 in a closed position. The anvil 28 may be closedhydraulically and returned to its open position by an energy storingdevice such as a spring 23. As can be seen in FIGS. 3-5, an actuationbladder 40 may be strategically mounted below a portion of the anvil 28such that when the bladder 40 is inflated with a pressurized fluid orair, it biases the anvil 28 to its open position. A supply line 42 iscoupled to the bladder 40 for supplying pressurized fluid from areservoir 232 as will be described in further detail below. Inalternative non-limiting embodiments, an additional hydraulic cylinderor cylinders may be advantageously employed to open and close the anvil.Still in other non-limiting embodiments, the anvil 28 may be opened andclosed by slidable action of a distal tube segment 410 attached thereto.

One type of cartridge that may be used with such end effector is alsodepicted in FIGS. 3-10. The staple cartridge 60 has a cartridge body 62that is divided by an elongated cutting slot 64 that extends from aproximal end 65 of the cartridge 60 toward a tapered outer tip 66. SeeFIG. 10. A plurality of staple-receiving channels 68 are formed withinthe staple cartridge body 64 and are arranged in spaced longitudinalrows 69 on each side of the elongated cutting slot 64. Positioned withinthe staple-receiving channels are staple drivers 70 that each supportone or more staples 72 thereon. The staples 72 are advanced or “fired”by moving their respective drivers 70 in an upward direction toward theanvil 28.

FIG. 10 depicts a three dimensional view of the end effector 22 in anopen position with a staple cartridge 60 installed in the elongatechannel 26. On a lower surface 30 of the anvil 28, a plurality ofstaple-forming pockets 32 are arrayed to correspond to each staplereceiving channel 68 in the cartridge body 62 when the cartridge 60 isinstalled in the end effector 22. More specifically, each forming pocket32 in the anvil 28 may correspond to an individual staple 72 locatedwithin the staple cartridge 60. The staple cartridge 60 may be snap-fitinto the elongate channel 26. For example, extension features 63 of thestaple cartridge 60 engage recesses 27 (shown in FIG. 6) of the elongatechannel 26.

In one embodiment, the staple drivers 70 are driven in an “upward”(toward the anvil 28) direction by a series of hydraulically actuatedbladders 90, 92, 94, 96, 98, 100 situated within the elongated slot 26of the end effector 22 and arranged such that when the bladders 90, 92,94, 96, 98, 100 are inflated, they drive or “fire” the correspondingdrivers 70 and their respective staples 72 toward the anvil 28. As theends of the staple legs contact the corresponding staple forming pockets32 in the anvil 28, they are bent over to close the staple 72. Variousfiring arrangements are disclosed in the above-mentioned patentapplication entitled SURGICAL INSTRUMENT HAVING A HYDRAULICALLY ACTUATEDEND EFFECTOR which has been herein incorporated by reference.Pressurized fluid or air is supplied to the bladders 90, 92, 94, 96, 98,100 through a series of supply lines as shown in FIGS. 6 and 11.

Also in one embodiment, to facilitate cutting of tissue 8 clamped in theend effector 22, a hydraulically actuated cutting bar 110 is operativelymounted within the elongated channel 26 and arranged to be receivedwithin the elongated slot 64 in the cartridge body 62 when the cartridge60 is mounted within the end effector 22. The cutting bar 110 extendslongitudinally along the elongate slot 64 and is mechanically coupled toor otherwise supported on a support bar 111 which is attached to ahydraulic cutting bladder 102. By introducing a pressurized fluid or airinto the cutting bladder 102, the cutting bar 110 is forced upward(represented by arrow A in FIG. 4) thereby causing the cutting bar 110to sever the tissue 8 that is clamped between the anvil 28 and thecartridge 60. After the cutting bar 110 has severed the tissue 8, thepressurized fluid is permitted to exit the cutting bladder 102 tothereby permit the bladder 102 to deflate and permit the cutting bar 110to move downward (arrow “B” in FIG. 3) to its retracted or unfiredposition. Pressurized fluid or air is supplied to the cutting bladder102 by supply line 256.

As can be seen in FIGS. 1 and 2, the handle assembly 200 may house ahydraulic system generally designated as 210 for controlling theoperation of the end effector 22. One embodiment of a hydraulic system210 that may be employed to control the end effector 22 is depicted inschematic form in FIG. 11. In this non-limiting embodiment, aconventional hydraulic pump assembly 230 that includes a fluid reservoir232 is employed to supply pressurized fluid to the various bladders. Inone embodiment, the pump 230 is powered by a battery 234 supportedwithin the handle assembly 200. However, the pump 230 could also bepowered by other means, such as by alternating current or by amechanical actuator. The pump 230 may be fluidically coupled to thereservoir 232 by supply line 236 that may have a conventional checkvalve 238 therein. See FIG. 11. As used herein, the term “fluidicallycoupled” means that the elements are coupled together with anappropriate supply, return, discharge, etc. line or other means topermit the passage of pressurized fluid medium, air, etc. therebetween.As used herein, the term “line” as used in “supply line”, “dischargeline” or “return line” refers to an appropriate fluid passage formedfrom conduit, pipe, tubing, etc. for transporting pressurized fluid,air, etc. from one component to another.

In one embodiment, a discharge line 240 attached to the discharge port231 of the pump 230 is piped to a manifold 242 that has designatedsupply lines for each bladder coupled thereto. For example, in theembodiment depicted in FIG. 11, a supply line 244 is coupled to bladder90 and has a control valve 260 therein for controlling the flow ofpressurized fluid through the line 244 to bladder 90. Supply line 246 iscoupled to bladder 92 and has a control valve 262 therein. Supply line248 is coupled to bladder 94 and has a control valve 264 therein. Supplyline 250 is coupled to bladder 96 and has a control valve 266 therein.Supply line 252 is coupled to bladder 98 and has a control valve 268therein. Supply line 254 is coupled to bladder 100 and has a controlvalve 270 therein. Supply line 256 is coupled to cutting bladder 102 andhas control valve 272 therein. Supply line 42 is coupled to the anvilbladder 40 and the supply line 240 by line 241. A supply valve 274 isprovided in line 241 for controlling the flow of pressurized fluidthereto and a return valve 276 is provided to permit the fluid to returnfrom the bladder 40 into the manifold line 242 and through a return line259 that is attached to the manifold 242 and the reservoir 232. As canbe seen in FIG. 11, the return line 259 may have a return valve 278therein. Valves 262, 264, 266, 268, 270, 272, 274, 276, 278 comprise avalve unit, generally designated as 280. In various non-limitingembodiments, the valves 262, 264, 266, 268, 270, 272, 274, 276, 278 mayeach comprise electrically actuated valves, such as, for example, piezovalves or Electro Active Polymer (EAP) valves which may be configured inresponse to an electrical signal. However, other suitable valve andvalve arrangements could be employed.

The above-described valves may be operated by a control circuit 300 inresponse to input received from input buttons, such as buttons 308, 310,312, 314, and/or 316 located on handle. The control circuit may also bepowered by the battery 234 and comprise a suitable circuit capable ofgenerating signals for configuring valve unit 280 in response to inputfrom buttons 308, 310, 312, 314, 316 and/or from other portions of thehandle such as a closure trigger 206 and/or a firing trigger 208 thatare pivotally coupled thereto. In one non-limiting embodiment, thecontrol circuit 300 may include a microprocessor and other relatedcomponents including Random Access Memory (RAM), Read Only Memory (ROM),etc. In other non-limiting embodiments, the control circuit 300 mayinclude various logical circuit elements.

As can be seen in FIGS. 1 and 2, in one non-limiting embodiment, thehandle assembly 200 of the instrument 10 includes a pistol grip 204 thatincludes a closure trigger 206 that is pivotally attached thereto tocommence closure of the anvil 28. In one embodiment, a closure triggersensor 205 is employed to sense when the closure trigger 206 has beenpivoted to the closed position. The closure trigger sensor 205communicates with the control circuit to open the return valve 276 andreturn valve 278 and close supply valve 274 to permit the pressurizedfluid to return from the anvil bladder 28 into the reservoir 232. Theanvil 28 is then pivoted to the closed position by the return spring 23.The closure trigger 206 may be retained in the closed position by arelease button latch arrangement 36 of the type disclosed in U.S. Pat.No. 6,905,057, entitled SURGICAL STAPLING INSTRUMENT INCORPORATING AFIRING MECHANISM HAVING A LINKED RACK TRANSMISSION, the disclosure ofwhich is herein incorporated by reference in its entirety. Anothernon-limiting embodiment links the closure trigger 206 to the tubeassembly 452 and causes it to move distally driving the distal tube 410over the end effector assembly 24 closing the system.

When the end effector 22 is in the closed position, it may be insertedthrough the trocar 490. See FIG. 9. To reopen the end effector 22, therelease button 36 is pressed to unlatch the closure trigger 206 toenable it to pivot away from the firing trigger 208 to an open position.When in the open position, the closure trigger sensor 205 signals thecontrol circuit 300 to power pump 230 and open supply valve 274 andclose return valve 276. Pressurized fluid is then pumped into the anvilbladder 40 to pivot the anvil 28 to the open position. When theclinician has oriented the end effector 22 such that the desired tissueis located between the open anvil 28 and the cartridge 60, the closuretrigger 206 is pivoted to the closed position and latched. Valves 276and 278 are opened and valve 241 is closed. Valves 276 and 278 areopened for a sufficient time to permit the fluid in the anvil bladder 40to be returned therefrom through the lines 42, 242 and 259. Thereafter,those valves are closed. As indicated above, the use of thehydraulically powered bladder and return spring arrangement describedherein is just one type of structure that may be employed to open andclose the anvil 28. Other anvil control arrangements may be employedwithout departing from the spirit and scope of the present inventionand, therefore, the protection afforded to the various embodiments ofthe present invention should not be limited solely to such bladder andreturn spring arrangement.

Input buttons 308, 310, 312, 314, 316 may provide input signals to thecontrol circuit 300 in any suitable way. In one non-limiting embodiment,each input button 308, 310, 312, 314, 316 may correspond to a particularvalve or valves for controlling the inflation of one or more bladders.While five actuation buttons are shown for this non-limiting embodiment,the reader will appreciate that other numbers of buttons may beemployed. For example, if it is desirable to only actuate one staplingbladder at a time, a separate actuation button for each bladder may beprovided. For example, button 308 may control valve 272 in the cuttersupply line 256. By actuating that valve 272, pressurized fluid suppliedby the pump 230 into the manifold 242 is permitted to flow through thesupply line 256 into the cutting bladder 102. Likewise, if actuatorbutton 310 is used to control valves 260, 262, activating the button 310will cause the stapling bladders 90 and 92 to inflate and fire theircorresponding staples 72. Multiple buttons may be selected to createfiring patterns including more than one implement. In other non-limitingembodiments, each input button 308, 310, 312, 314, 316 may represent apre-determined firing order and/or pattern. For example, selecting abutton 308, 310, 312, 314, 316 may cause the control circuit 318 toconfigure the valve unit 304 such that hydraulic devices correspondingto particular surgical implements are fired when the firing trigger 28is depressed. It will be appreciated that various embodiments may havemore or fewer input buttons than are shown. In one embodiment, a firingtrigger 208 is pivotally attached to the handle 200 outboard of theclosure trigger 206 and one or more firing sensors (not shown) may bepositioned to detect the position of the firing trigger. The firingsensors would then communicate with the control circuit 300 to controlthe various valves to permit pressurized fluid to flow to the variousstaple bladders to achieve a desired firing sequence.

In various non-limiting embodiments, the valve unit 280 may beconfigured to introduce a delay to the driving of one or more surgicalimplements included in the end effector 12. For example, it may bedesirable to drive a cutting implement and then delay for apredetermined time before driving one or more zones of a staplingimplement. The delay may be accomplished according to any suitablemethod. In one non-limiting embodiment, the control circuit 300 mayconfigure the valve unit 280 to open a path for hydraulic fluid betweenthe hydraulic pump 230 and a first surgical implement included in theend effector 12. When the firing trigger 28 is actuated, the pump 302may generate pressurized hydraulic fluid, which drives the firstsurgical implement. The control circuit 300 may sense when the firstsurgical implement is driven (e.g., by sensing the position of thefiring trigger 208) and begin a timer that counts off a predetermineddelay time. At the expiration of the predetermined delay time, thecontrol circuit 318 may configure the valve unit 280 to provide thepressurized hydraulic fluid to a second surgical implement. Hydraulicpressure generated at the actuation of the firing trigger 208 may besufficient to drive the second surgical implement, or in variousembodiments, the hydraulic pump 230 may be utilized to generateadditional hydraulic pressure.

In one non-limiting embodiment of the present invention, the endeffector 22 may be attached to the handle assembly 200 by anarticulating joint assembly, generally designated as 400. As can be seenin FIGS. 1, 2, and 12-14, the articulating joint assembly 400 includes adistal tube segment 410 that has a distal end 412, a proximal end 414,and a distal axis H-H. The distal end 412 is mechanically (e.g., rigidlyor slidably connected—depending upon the anvil closure arrangementemployed) coupled to the end effector body 24. The distal tube 410segment may be partially hollow with the proximal end being solid with ahose/wire receiving passage 416 therethrough.

The joint assembly 400 further includes a proximal tube segment 450,that has a proximal end 452, a distal end 454, and a proximal axis I-I.The proximal end 452 is attached to the handle assembly 200. In oneembodiment, for example, the proximal end 452 may be attached to thehandle assembly 200 by an internal channel retainer that is grounded tothe handle assembly. However, other fastening arrangements could beemployed. In one embodiment, the distal end 454 is solid and has ahollow hose/wire-receiving passage 456 therethrough. The remainingportion of the tube segment 450 may be hollow to permit passage of hosesand/or wires therethrough.

In one embodiment, the distal tube segment 410 is pivotally coupled tothe proximal tube segment 450 by a ball joint assembly 460. In oneembodiment, the ball joint assembly 460 comprises a hollow ball member462 that is mounted to or formed on the proximal end 414 of the distaltube segment 410. The ball member 462 is substantially hollow or has ahollow passageway therein to permit the passage of hoses and/or wirestherethrough. The ball member 462 is received in a socket 458 providedin the distal end of the proximal tube segment 450, such that the ballmember 462 is free to pivot therein.

In one embodiment, an actuation assembly, generally designated as 500 isemployed to articulate the distal tube segment 410 relative to theproximal tube segment 450. As can be seen in FIGS. 11-14, in onenon-limiting embodiment, two articulation cylinders 510, 520 areemployed. First articulation cylinder 510 may comprise a conventionalhydraulic or pneumatic cylinder that has a first housing 512 thatcontains a first piston 514 therein. A first piston rod or firstactuation rod 516 is attached to the first piston 514 and protrudes outof the first housing 512. Movement of the piston 514 within the firsthousing 512 in response to the admission of pressurized fluid or air onone side or the other side of the piston 514 causes the first actuationrod 516 to be extended out of the first cylinder housing 512 or into thefirst cylinder housing 512. A distal end 518 of the first housing 512 ispivotally (pinned) or otherwise rigidly attached to the proximal end 414of the distal tube segment 410. The first actuation rod 516 isfabricated from a flexible material such as rubber or the like and thefree end 519 thereof is rigidly affixed to the distal end 454 of theproximal tube segment 450. The free end 519 of the first actuation rod516 may be attached to the distal end 454 by gluing, threads, etc. Afirst indentation 466 or a series of indentations are provided in theouter surface 464 of the ball member to provide the requisite clearancefor the first actuation rod 516 and also the end of the first cylinderhousing 512.

Also in this non-limiting embodiment, the second articulation cylinder520 may comprise a conventional hydraulic or pneumatic cylinder that hasa second housing 522 that contains a second piston 524 therein. A secondpiston rod or second actuation rod 526 is attached to the second piston526 and protrudes out of the second housing 522. Movement of the secondpiston 524 within the second cylinder housing 522 in response to theadmission of pressurized fluid or air on one side or the other side ofthe second piston 524 causes the actuation rod 526 to be extended out ofthe second cylinder housing 522 or into the second cylinder housing 522.The second cylinder housing 522 is pivotally (pinned) or otherwiserigidly attached to the proximal end 414 of the distal tube segment 410.The second actuation rod 526 is fabricated from a flexible material suchas rubber or the like and the free end 529 thereof is rigidly affixed tothe distal end 454 of the proximal tube segment 450. The free end 529 ofthe second actuation rod 526 may be attached to the distal end 454 bygluing, threads, etc. A second indentation 468 or a series ofindentations are provided in the outer surface 464 of the ball member462 to provide the requisite clearance for the second actuation rod 526and also the end of the second cylinder housing 522.

The first and second articulation cylinders 510, 520 may be powered bythe hydraulic system 210 or they may be powered by a separate hydraulicsystem. FIG. 11 depicts one method of controlling the first and secondarticulation cylinders 510, 520. As can be seen in that Figure, a supplyline 570 is connected to the supply line 240 from the pump 230. A firstportion 572 of the supply line 570 is attached to a first supply port inthe first cylinder housing 512 for supplying pressurized fluid or airinto the first cylinder housing 512 on one side of the first piston 514and a second portion 574 of the supply line 570 is attached to a secondsupply port in the first housing 512 for supplying pressurized fluid orair into the first housing 512 on the other side of the first piston514. A first supply valve 576 is mounted in the first portion 572 of thesupply line 570 and a second supply valve 578 is mounted in the secondportion 574 of the first supply line 570. An exhaust or return line 580is provided to return the pressurized fluid from the first housing 512to the fluid reservoir 232. The return line 580 has a first portion 582and a second portion 584 attached to ports in the first housing 512. Afirst return valve 586 is mounted in the first portion 582 of the returnline 580 and a second return valve 588 is mounted in the second portion584 of the return line.

The supply line 570 further has a third portion 590 that is coupled to athird supply port in the second housing 522 on one side of the secondpiston 524 and the supply line 570 has a fourth portion 592 coupled to afourth supply port in the second housing 522 on the other side of thesecond piston 524. A valve 596 is mounted in the third portion 590 andanother valve 598 is mounted in fourth portion 592 of the supply line570. Another return line 600 is provided to permit the pressurizedfluid, air, etc. to return to the reservoir 232 from the housing 522during actuation of the cylinder 520. The return line 600 has a thirdportion 602 attached to a third return port in the second housing 522 onone side of the second piston 524 and a fourth portion 604 of the returnline 600 is coupled to a fourth return port in the second housing 522 onthe other side of the second piston 524. A return valve 606 is providedin the third portion 602 of the return line 600 and another return valve608 is provided in the portion 604 of the return line 600.

The valves may be controlled by the control circuit 300 or a secondcontrol circuit 300′ of the type described above that may include amicroprocessor and other related components including Random AccessMemory (RAM), Read Only Memory (ROM), etc. In other non-limitingembodiments, the control circuit 300′ may include various logicalcircuit elements. A conventional multiposition switch 610 or a series ofswitches, push buttons etc. may be connected to the second controlcircuit 300′ for controlling the valves 576, 578, 586, 588, 594, 596,606, 608 to control the cylinders 510, 520 in the manners necessary toachieve the desired degree and direction of articulation.

When pivotally attached together as described above, the proximal anddistal tube segments 410, 450 form a tube assembly 470 that has apassageway 472 or passageways for supporting the supply lines(collectively designated as 480) between the end effector 22 and thehandle 200. It will be appreciated that the tube assembly 470 has acircumference “C” and shape such that when the distal tube 410 segmentis coaxially aligned with the proximal tube segment 450, the tubeassembly 470 may be inserted through the passageway 492 in a trocar 490.See FIG. 9. In one embodiment, the first and second tube segments 410,450 have a round cross-sectional shape and are sized to be axiallyinserted through a round trocar passageway 492. The outer diameters ofeach the distal tube segments 410, 450 are less than the inner diameterof the trocar passageway 492 to facilitate axial insertion of the tubeassembly 470 through the trocar passage 492 and, if desired ornecessary, rotation of the tube assembly 470 within the trocarpassageway 492. For example, if the trocar passageway 492 has an innerdiameter of approximately 12.8 mm (0.503 inches), the maximum outerdiameter of tube assembly 470 (and of each of the tube segments 410,450) may be approximately 12.7 mm (0.500 inches). It is conceivablethat, for applications wherein the ability to rotate the tube assembly470 within the trocar passageway 492 is not necessary or desirable,trocars with passageways having non-circular cross-sections could beemployed. In those cases, the tube assembly would have a cross-sectionalshape that would facilitate axial insertion of the tube assembly throughthe trocar passageway and may closely resemble the cross-sectional shapeof the trocar passageway. Thus, the various embodiments of the subjectinvention should not be limited to devices having a tube assembly with around cross-sectional shape.

FIG. 1 illustrates the joint assembly in a non-articulated position thatwould enable the tube assembly 470 to be inserted into the trocar. Afterthe surgical implement 12 has been inserted through the trocar 490 andit becomes desirable to articulate the implement 12, the clinicianactivates the control circuit 300′ through switch 610. Depending uponthe degree and direction of articulation desired, the first piston 516and the second piston 526 may either both be extended, one extended andone retracted or both retracted to cause the ball member 462 to pivot inthe socket to achieve the desired amount of articulation. The pistons516 and 526 are extended by the clinician by activating multipositionswitch or buttons located on the handle assembly to cause the controlcircuit 300′ to open and close the various control valves 576, 578, 586,588, 594, 596, 606, 608. The reader will appreciate that the first andsecond actuation rods 516, 526 may, depending upon the forces, tend tobend rather than pivot during actuation and it is the deflection andbuckling of these rods 516, 526 that further causes the distal tubesegment 410 to articulate relative to the proximal tube segment 450.Moreover, if the articulation cylinders 510, 520 are not aligned 180degrees about the longitudinal axis of the device, they can be used toarticulate the end effector in multiple planes as well as merelypivoting it about a point perpendicular to the longitudinal axis. Suchpivotal flexibility is made possible through use of the ball jointarrangement of this embodiment. Such arrangement represents asignificant improvement over other arrangements that can only articulateabout a single axis.

The hydraulic control system described above for actuating thearticulation cylinders 510, 520 is but one example of a control systemthat may be used. The reader will appreciate that a variety of differentcontrol arrangements may be employed to activate the articulationcylinders without departing from the spirit and scope of the presentinvention. For example, the articulation cylinders 510, 520 as describedabove require the admission of pressurized fluid/air to move theirrespective pistons in both directions. Other cylinders that employsprings or other mechanisms for returning the pistons to a startingposition may be employed along with appropriate valve and hydraulicfluid supply arrangement that are within the capabilities of the skilledartisan may be employed. It will be further appreciated that, while twoarticulation cylinders have been described above, other embodiments ofthe present invention may employ only one articulation cylinder or morethan two articulation cylinders. Also, while the ball member 462 hasbeen described as being non-movably mounted to the distal tube segment410 with the socket 458 provided in the proximal tube segment 450, thoseof ordinary skill in the art will understand that the ball member 462may be non-movably attached to the proximal tube segment 450 and thesocket 458 provided in the distal tube segment 410 in other non-limitingembodiments without departing form the sprit and scope of the presentinvention.

FIG. 15 illustrates another articulation joint assembly 1400 embodimentof the present invention. As can be seen in that Figure, distal tubesegment 1410 has a proximal end 1414 and a distal axis H′-H′. Althoughnot shown in FIG. 15, the distal tube segment 1410 has a distal end 1412that is mechanically coupled to the end effector body 24. Depending uponthe anvil closure arrangement employed, the distal end 1412 may benon-movably attached to the end effector body or by a cable, flexiblemember or pivotable member. The distal tube 1410 segment may bepartially hollow with the proximal 1414 end being solid with a hose/wirereceiving passage 1416 therethrough.

The joint assembly 1400 further includes a proximal tube segment 1450,that has a distal end 1454, and a proximal axis I′-I′. Although notshown in FIG. 15, the proximal tube segment 1450 has a proximal end thatis mechanically attached to the handle assembly 200.

In one embodiment, the distal tube segment 1410 is pivotally coupled tothe proximal tube segment 1450 by a ball joint assembly 1460. In oneembodiment, the ball joint assembly comprises a hollow ball member 1462that is mounted to or is formed on the distal end 1454 of the proximaltube segment 1450. The ball member 1462 has a hollow passageway 1464that has a flared or otherwise enlarged end portion 1465 to enable it tocommunicate with the passageway 1416 such that, regardless of theposition of the ball member 1462, the hoses 480 and/or wires extendingtherethrough will not be pinched or otherwise damaged. The ball member1462 is received in a socket 1458 provided in the proximal end 1414 ofthe distal tube segment 1410, such that the ball member 1462 is free topivot or rotate therein.

In one embodiment, an actuation assembly, generally designated as 1500is employed to articulate the distal tube segment 1410 relative to theproximal tube segment 1450. As can be seen in FIG. 15, in onenon-limiting embodiment, two articulation cylinders 1510, 1520 areemployed. First articulation cylinder 1510 may comprise a conventionalhydraulic or pneumatic cylinder that has a first housing 1512 thatcontains a first piston 1514 therein. A first piston rod or firstactuation rod 1516 is attached to the first piston 1514 and protrudesout of the first housing 1512. Movement of the piston 1514 within thefirst housing 1512 in response to the admission of pressurized fluid orair on one side or the other side of the piston 1514 causes the firstactuation rod 1516 to be extended out of the first cylinder housing 1512or into the first cylinder housing 1512. A distal end 1518 of the firsthousing 1512 is pivotally (pinned) to a portion 1415 of the proximal end1414 of the distal tube segment 1410. The outer surface of the proximalend 1414 in the area of the first cylinder housing 1512 may be contouredto facilitate pivotal movement of the cylinder housing 1512. The firstactuation rod 1516 may be fabricated from a flexible material such asrubber or the like or it may be fabricated from rigid material. The freeend 1519 of the actuation rod 516 is pivotally pinned to or otherwiseattached to the distal end 1454 of the proximal tube segment 1450.

Also in this non-limiting embodiment, the second articulation cylinder1520 may comprise a conventional hydraulic or pneumatic cylinder thathas a second housing 1522 that contains a second piston 1524 therein. Asecond piston rod or second actuation rod 1526 is attached to the secondpiston 1524 and protrudes out of the second housing 1522. Movement ofthe second piston 1524 within the second cylinder housing 1522 inresponse to the admission of pressurized fluid or air on one side or theother side of the second piston 1524 causes the actuation rod 1526 to beextended out of the second cylinder housing 1522 or into the secondcylinder housing 1522. The distal end 1523 of the second cylinderhousing 1522 is pivotally (pinned) to a portion 1417 of the proximal end1414 of the distal tube segment 1410. The outer surface of the proximalend 1414 in the area of the second cylinder housing 1522 may becontoured to facilitate pivotal movement of the cylinder housing 1522.The second actuation rod 1526 may be fabricated from a flexible materialsuch as rubber or the like or it may be fabricated from rigid material.The free end 1529 of the actuation rod 1526 is pivotally pinned to orotherwise attached to the distal end 1454 of the proximal tube segment1450.

The first and second articulation cylinders 1510, 1520 may be powered bythe hydraulic system 210 in the same manner as was discussed in detailabove with respect to cylinders 510, 520 or they may be powered by aseparate hydraulic system. FIG. 11 depicts one method of controlling thefirst and second articulation cylinders 1510, 1520. The distal tubesegment 1410 (and the end effector 22 attached thereto) may bearticulated relative to the proximal tube 1450 in the direction shown inFIG. 15 by extending the actuation rod 1526 and retracting the actuationrod 1516. Likewise, the distal tube segment 1410 may be pivoted to adirection opposite to the direction shown in FIG. 15 by extending theactuation rod 1516 and retracting the actuation rod 1526. The controlcircuit 300′ may actuate the cylinders 1510, 1520 in these manners inresponse to the position of the multiposition control switch 610 on thehandle assembly 200. The reader will also appreciate that, while twoarticulation cylinders have been described above, other embodiments ofthe present invention may employ only one articulation cylinder if onlyone degree articulation is needed or desired. Also, while the ballmember 1462 has been described as being non-movably mounted to theproximal tube 1450 with the socket 1458 provided in the distal tubesegment 1410, those of ordinary skill in the art will understand thatthe ball member 1462 may be non-movably attached to the distal tubesegment 1410 and the socket 1458 provided in the proximal tube segment1450 in other non-limiting embodiments without departing from the spiritand scope of the present invention.

In an alternative embodiment depicted in FIG. 15A, the joint assembly1460′ comprises a round disc-like member 1462′ instead of a ball shapedmember. The disc 1462′ has a hollow passageway 1464′ that has a flaredor otherwise enlarged end portion 1465′ to enable it to communicate withthe passageway 1416 such that, regardless of the position of thedisc-like member 1462′, the hoses 480 and/or wires extendingtherethrough will not be pinched or otherwise damaged. The disc-likemember 1462′ is received in a socket 1458′ provided in the proximal end1414 of the distal tube segment 1410, such that the disc-like member1462′ is free to pivot therein. If desired, the outer edge of thedisc-like member 1462′ could be provided with a tongue (not shown) thatis received in a groove (not shown) in the socket wall to furtherstabilize the disc-like member 1462′. This embodiment otherwise employsactuators 1510 and 1520 as described above. Again, however, the readerwill appreciate that, while two articulation cylinders have beendescribed above, other embodiments of the present invention may employonly one articulation cylinder if only one degree articulation is neededor desired. Also, while the disc-like member 1462′ has been described asbeing non-movably mounted to the proximal tube segment 1450 with thesocket 1458′ provided in the distal tube segment 1410, those of ordinaryskill in the art will understand that the disc-like member 1462′ may benon-movably attached to the distal tube segment 1410 and the socket1458′ provided in the proximal tube segment 1450 in other non-limitingembodiments without departing from the spirit and scope of the presentinvention.

Another alternative embodiment is depicted in FIG. 16. As can be seen inthis embodiment, the end 1519 of the first actuation rod 1516 ofcylinder 1510 is attached to portion of the outer surface of the ballmember 1462 and the end 1529 of the second actuation rod 1516 is alsoattached to a portion of the ball member 1462. This embodiment isotherwise identical in composition and operation as the embodimentdepicted in FIG. 15 and described above. Again, however, the reader willappreciate that, while two articulation cylinders have been describedabove, other embodiments of the present invention may employ only onearticulation cylinder if only one degree articulation is needed ordesired. Also, while the ball member 1462 has been described as beingnon-movably mounted to the proximal tube segment 1450 with the socket1458 provided in the distal tube segment 1410, those of ordinary skillin the art will understand that the ball member 1462 may be non-movablyattached to the distal tube segment 1410 and the socket 1458 provided inthe proximal tube segment 1450 in other non-limiting embodiments withoutdeparting from the sprit and scope of the present invention.

Another alternative embodiment is depicted in FIG. 16A. As can be seenin this embodiment, the end 1519 of the first actuation rod 1516 ofcylinder 1510 is attached to portion of the outer surface of thedisc-like member 1462′ and the end 1529 of the second actuation rod 1516is also attached to a portion of the disc-like member 1462′. Thisembodiment is otherwise identical in composition and operation as theembodiment depicted in FIG. 16A and described above. Again, however, thereader will appreciate that, while two articulation cylinders have beendescribed above, other embodiments of the present invention may employonly one articulation cylinder if only one degree articulation is neededor desired. Also, while the disc-like member 1462′ has been described asbeing non-movably mounted to the proximal tube segment 1450 with thesocket 1458′ provided in the distal tube segment 1410, those of ordinaryskill in the art will understand that the disc-like member 1462′ may benon-movably attached to the distal tube segment 1410 and the socket1458′ provided in the proximal tube segment 1450 in other non-limitingembodiments without departing from the spirit and scope of the presentinvention.

FIG. 17 illustrates yet another articulation joint assembly 2400embodiment of the present invention. As can be seen in that Figure,distal tube segment 2410 has a proximal end 2414 and a distal axisH″-H″. Although not shown in FIG. 17, the distal tube segment 2410 has adistal end that is mechanically coupled to the end effector body 24.Depending upon the anvil closure arrangement employed, the distal endmay be non-movably attached to the end effector body or by a cable,flexible member or pivotable member. The distal tube 2410 segment may bepartially hollow with the proximal end 2414 being solid with a hose/wirereceiving passage 2416 therethrough. The passage 2416 may have a conicalshaped portion 2417.

The joint assembly 2400 further includes a proximal tube segment 2450,that has a distal end 2454, and a proximal axis I″-I″. Although notshown in FIG. 18, the proximal tube segment 2450 has a proximal end 2454that is attached to the handle assembly 200.

In one embodiment, the distal tube segment 2410 is pivotally coupled tothe proximal tube segment 2450 by a ball joint assembly 2460. In oneembodiment, the ball joint assembly 2460 comprises a ball member 2462that is mounted to or is formed on the distal end 2454 of the proximaltube segment 2450. The ball member 2462 has a hollow passageway 2464that has a flared or otherwise enlarged end portion 2465 to enable it tocommunicate with the passageway portions 2416, 2417 such that,regardless of the position of the ball member 2462, the hoses 480 and/orwires extending therethrough will not be pinched or otherwise damaged.The ball member 2462 is received in a socket 2458 provided in theproximal end 2414 of the distal tube segment 2410, such that the ballmember 2462 is free to rotate therein.

In one embodiment, an actuation assembly, generally designated as 2500is employed to articulate the distal tube segment 2410 relative to theproximal tube segment 2450. As can be seen in FIG. 17, in onenon-limiting embodiment, two flexible worm gear cables 2510, 2520 areemployed. The first flexible worm gear cable 2510 is adapted todrivingly engage worm gear teeth, threads, etc. (not shown) within afirst gear passage 2465 formed in the ball member 2462. The firstflexible worm gear cable 2510 is coupled to a first motor 2512 that ismounted within the distal tube segment 2410. Similarly, in thisnon-limiting embodiment, a second flexible worm gear cable 2520 isadapted to drivingly engage gear teeth, threads, etc. within a secondgear passage 2467 formed in the ball member 2462 that has worm gearteeth, threads, etc. 2469 formed therein. The second flexible worm gearcable 2520 is coupled to a second motor 2522 mounted in the distal tubesegment 2410. While described herein as “flexible worm gear cables”, itwill be understood that this term is meant to encompass all types offlexible driven cable or driver arrangements that do not necessarilyemploy worm gear-type teeth thereon.

The first and second motors 2512, 2522 may be electrically powered (bybattery 234 or another battery) or be powered by alternating current orbe powered by hydraulic fluid or air. In one embodiment, the motors2512, 2522 are electric powered and are operated by one or more switchesor buttons (not shown) on handle assembly 200. By controlling the amountof rotation and the direction of rotation of the first and second wormgear cables 2510, 2520, the ball member 2462 is cause to rotate withinthe socket 2458 and thereby articulate the distal tube segment 2410 (andthe end effector 22 attached thereto) relative to the proximal tubesegment 2450. The reader will appreciate that such arrangementfacilitates left articulation as shown in FIG. 17 and right articulation(not shown). Again, however, the reader will appreciate that, while twoflexible worm gear cable/motor arrangements have been described above,other embodiments of the present invention may employ only one flexibleworm gear cable arrangement if only one degree articulation is needed ordesired. Also, while the ball member 2462 has been described as beingnon-movably mounted to the proximal tube segment 2450 with the socket2458 provided in the distal tube segment 2410, those of ordinary skillin the art will understand that the ball member 2462 may be non-movablyattached to the distal tube segment 2410 and the socket 2458 provided inthe proximal tube segment 2450 in other non-limiting embodiments withoutdeparting from the spirit and scope of the present invention.

In an alternative embodiment depicted in FIG. 17A, the joint assembly2460′ comprises a round disc-like member 2462′ instead of a ball shapedmember. The disc-like member 2462′ has a hollow passageway 2464′ thathas a flared or otherwise enlarged end portion 2465′ to enable it tocommunicate with the passageway 2416 such that, regardless of theposition of the disc-like member 2462′, the hoses 480 and/or wiresextending therethrough will not be pinched or otherwise damaged. Thedisc-like member 2462′ is received in a socket 2458′ provided in theproximal end 2414 of the distal tube segment 2410, such that thedisc-like member 2462′ is free to rotate therein. If desired, the outeredge of the disc-like member 2462′ could be provided with a tongue (notshown) that is received in a groove (not shown) in the socket wall tofurther stabilize the disc-like member 1462′. This embodiment otherwiseemploys the motor driven flexible worm gear cables 2510 and 2520 asdescribed above. Again, however, the reader will appreciate that, whiletwo flexible worm gear cable/motor arrangements have been describedabove, other embodiments of the present invention may employ only oneflexible worm gear cable arrangement if only one degree articulation isneeded or desired. Also, while the disc-like member 2462′ has beendescribed as being non-movably mounted to the proximal tube segment 2450with the socket 2458′ provided in the distal tube segment 2410, those ofordinary skill in the art will understand that the disc-like member2462′ may be non-movably attached to the distal tube segment 2410 andthe socket 2458′ provided in the proximal tube segment 2450 in othernon-limiting embodiments without departing from the spirit and scope ofthe present invention.

The terms “proximal” and “distal” are used herein with reference to aclinician gripping a handle of an instrument. For example, referring tothe surgical instrument 3010 shown in FIG. 18, the end effector 3012 isdistal with respect to the more proximal handle portion 3020. It will befurther appreciated that for convenience and clarity, spatial terms suchas “vertical” and “horizontal” are used herein with respect to thedrawings. However, surgical instruments are used in many orientationsand positions, and these terms are not intended to be limiting andabsolute.

The surgical instrument 3010 of FIG. 18 includes a handle portion 3020and an implement portion 3022. The implement portion 3022 includes ashaft 3023 and an end effector 3012. The end effector 3012 shown in FIG.18 is configured to act as an endocutter including surgical implementsfor clamping, stapling and severing, however, it will be appreciatedthat the advantages of the present invention may be achieved with endeffectors (not shown) including alternate and/or additional surgicalimplements.

Referring back to the non-limiting embodiment shown in FIG. 18, thehandle portion 3020 of the instrument 3010 includes a pistol grip 3024toward which a closure trigger 3026 is pivotally drawn by a clinician tocause clamping, or closing, of the anvil 3018 toward the elongatechannel 3016 of the end effector 3012. A firing trigger 3028 is fartheroutboard of the closure trigger 3026 and is pivotally drawn by theclinician to cause the stapling and severing of clamped tissue in theend effector 3012.

The force necessary to cause the closure, stapling, and severing oftissue may be provided by a plurality of hydraulic devices (not shown inFIG. 18) located in the end effector 3012 such as, for example,bladders, cylinders, etc. In various embodiments, the hydraulic devicesmay be supplied with pressurized hydraulic fluid via hydraulic linebundle 3306 extending from handle 3020 of the instrument 3010 to the endeffector 3012, for example, through the elongate shaft 3023.

FIGS. 19-22 show views of the end effector 3012 configured to performclamping, severing and stapling of tissue according to variousembodiments the present invention. The end effector 3012 may includeanvil 3018 and elongate channel 3016 configured to receive a staplecartridge 3037. The anvil 3018 may pivot towards the elongate channel3016 and staple cartridge 3037 about anvil pivot 3014. FIG. 19 shows theanvil 3018 in an open position, while FIG. 20 shows the anvil 3018 in apivoted or closed position.

Force necessary to pivot or drive the anvil 3018, in variousembodiments, may be provided by closure sleeve 3032. For example, whenthe clinician actuates closure trigger 3026, the closure sleeve 3032 maybe translated distally toward the end effector driving the anvil 3018into the closed position shown in FIG. 20. When the closure trigger 3026is released, the closure sleeve 3032 may be translated proximally awayfrom the end effector 3012. The instrument 3010 may include a spring orother energy storage device causing the anvil 3018 to return to the openposition shown in FIG. 19 when the closure sleeve 3032 is retracted.Force may be transferred from the closure trigger 3026 to the closuresleeve 3032 by any mechanism known in the art including, for example, agear system, an electric motor, a hydraulic device, etc.

Referring back to FIG. 19, the end effector 3012 may include atransversely presented cutting edge 3326. The cutting edge 3326 may bedriven by a hydraulic cutting bladder 3322 positioned below the cuttingedge 3326. A cutting bar 3324 may be positioned between the cuttingbladder 3322 and cutting edge 3326. In various embodiments, the cuttingbladder 3322, bar 3324 and edge 3326 may be fastened to one another. Itwill be appreciated that the hydraulic cutting bladder 3322, in variousnon-limiting embodiments, may be replaced by any kind of hydraulicdevice including, for example, a hydraulic cylinder. In response to aclinician actuating the firing trigger 3028, the hydraulic cuttingbladder 3322 may expand in a transverse direction. This drives thecutting edge 3326, causing it to move through the elongate channel 3016and staple cartridge 3037 in a transverse direction and sever any tissue(not shown) present between the anvil 3018, staple cartridge 3037 andelongate channel 3016, for example, as described in more detail belowwith reference to FIGS. 37-43.

Referring again to FIG. 20 a cross sectional view of the end effector3012 is shown including staples 3222 and staple drivers 3220 accordingto various embodiments. A plurality of staples 3222 and staple drivers3220 are shown positioned adjacent the cutting edge 3326. Each stapledriver 3220 may be positioned below one, or a plurality of staples 3222included in the staple cartridge 3037. A staple hydraulic bladder 3327may be positioned below the staple drivers 3220. The staple hydraulicbladder 3327 may be expandable in a transverse direction toward stapledrivers 3220. The staple hydraulic bladder 3327 may expand in responseto the actuation of the firing trigger 3028 by the clinician. Expansionof the staple hydraulic bladder 3327 forces the staple drivers 3220 andstaples 3222 toward staple forming pockets (not shown in FIG. 20)present in the anvil 3018, thus driving the staples.

FIG. 21 shows a three dimensional view of the end effector 3012 of theinstrument 3010 with a portion of the staple cartridge 3037 removed toexpose features of the elongate channel 3016, such as recesses 3212,3214, and components of the staple cartridge 3037, such as stapledrivers 3220, in their unfired position. The cutting edge 3326 is shownat its unfired position, located in the center of staple drivers 3220.FIG. 21 also shows tissue stops 3244 located at the proximal end of theanvil 3018. Tissue stops 3244 may, in various embodiments, preventtissue from coming into contact with components of the anvil pivot 3014,causing the end effector 3012 to jam.

FIG. 22 depicts a three dimensional view of the end effector 3012 in anopen position with a staple cartridge 3037 installed in the elongatechannel 3016. On a lower surface 3200 of the anvil 3018, a plurality ofstapling forming pockets 3202 are arrayed to correspond to a pluralityof staple apertures 3204 in an upper surface 3206 of the staplecartridge 3037. Each aperture 3204 may correspond to an individualstaple 3222 located within the staple cartridge 3037 immediately belowthe aperture 3204 as shown in FIG. 20. Slot 3049, positioned in themiddle of the staple cartridge 3037, may enclose the cutting edge 3326(not shown in FIG. 22). The staple cartridge 3037 may be snap-fit intothe elongate channel 3016. For example, extension features 3208, 3210 ofthe staple cartridge 3037 engage recesses 3212, 3214 (shown in FIG. 21)of the elongate channel 3016.

In various embodiments, staples 3222 included in the end effector 3012may be driven according to one or more staple zones, with each staplezone able to be fired or driven separately. FIGS. 23-25 show anon-limiting zoned embodiment including six staple zones, with eachstaple zone including one hydraulic device and one staple driverconfigured to drive a plurality of staples. For example, a right distalstaple zone includes right distal staple bladder 3332 (shown in FIG.23), and right distal staple driver 3370 (shown in FIG. 24). It will beappreciated that various non-limiting embodiments of the presentinvention may include more or fewer than six staple zones depending onthe application, with each zone including as many or as few staples asdesired. It will also be appreciated that that individual staple zonesaccording to various embodiments of the present invention may includemultiple staple bladders and/or staple drivers.

Referring back to FIG. 23, a top down view of the elongate channel 3016is shown including six hydraulic staple bladders 3328, 3330, 3332, 3334,3336 and 3338. Each of the bladders may correspond to one of the sixzones of staples. The bladders 3328, 3330, 3332, 3334, 3336, 3338 aswell as cutting bladder 3322 (positioned below cutting bar 3324 in FIG.27) may be individually provided with pressurized hydraulic fluidthrough respective hydraulic lines 3340, 3342, 3344, 3346, 3348, 3350,3352 included in hydraulic line bundle 3306. Accordingly, in variousembodiments, each of bladders 3328, 3330, 3334, 3336, 3338 and 3322 maydrive associated surgical implements individually or according to afiring pattern.

FIG. 24 shows a top down view of the elongate channel 3016 and staplecartridge 3037 with the upper surface 3206 of the staple cartridge 3037removed to show staple drivers 3370, 3372, 3374, 3376, 3378, 3380. Eachstaple driver may correspond to one of the six staple zones. Also, eachstaple driver 3370, 3372, 3374, 3376, 3378, 3380 is positioned above thestaple bladder 3328, 3330, 3332, 3334, 3336, 3338 (shown in FIG. 27)corresponding to the same staple zone. For example, right distal staplebladder 3332 is positioned above the right distal staple driver 3370. Itwill be appreciated that it is not necessary to have only one stapledriver corresponding to each staple bladder 3328, 3330, 3332, 3334,3336, 3338. For example, in one non-limiting embodiment, a staple driver3220 may be provided for each individual staple 3222.

FIG. 25 shows an exploded three dimensional view of the elongate channel3016 with staple cartridge 3037 implementing the staple zone schemeshown in FIGS. 23 and 24. The staple cartridge 3037 may include staplerecesses 3354, 3356, 3358, 3360, 3362, 3364. Each staple recess mayhouse staples 3222 (not shown in FIG. 25) and one of staple drivers3370, 3372, 3374, 3376, 3378 (not shown in FIG. 25). When the staplecartridge 3037 is installed in the elongate channel 3016, each staplerecess, including staples 3222 and the staple drivers described above,may align with at least one staple bladder 3328, 3330, 3332, 3334, 3336,3338. When the staple bladders 3328, 3330, 3332, 3334, 3336, 3338 areinflated, they may extend into the staple recesses 3354, 3356, 3358,3360, 3362, 3364, creating a transverse force against the staple drivers3370, 3372, 3374, 3376, 3378, which in turn drive the staples 3222. FIG.25 also shows that the staple cartridge 3037 may include channels 3366for receiving hydraulic lines 3340, 3342, 3344, 3346, 3348, 3350, 3352,shown in FIG. 27. The channels 3366 prevent the various hydraulic linesfrom being pinched between the staple cartridge 3037 and the elongatechannel 3016.

FIG. 26 shows a cross-sectional view of the end effector 3012 showingthe configuration of bladders 3328, 3334, 3322, 3338 and 3334 accordingto various embodiments. Bladder 3328 is shown positioned below stapledriver 3370. Inflating bladder 3328 causes a transverse force to beexerted on the driver 3370, which may drive the staple 3222. The otherstaple bladders 3334, 3338 and 3334 shown in FIG. 26 may operate in asimilar fashion. Cutting bladder 3322 may also create a transverse forcewhen inflated. The transverse force may cause cutting bar 3324 to risetransversely, pushing cutting edge 3326 transversely through any tissue(not shown) present in the end effector 3012.

FIG. 27 shows the implement portion 3022 of the surgical stapling andsevering instrument 3010 in disassembled form. The staple cartridge 3037is shown comprised of a cartridge body 3216, staple drivers 3370, 3372,3374, 3376, 3378, 3380, cutting edge 3326 and staples 3222. Whenassembled, the cartridge body 3216 holds the staple drivers 3370, 3372,3374, 3376, 3378, 3380 and staples 3222. When the implement portion 3022is assembled, cutting bladder 3322, cutting bar 3324 and cutting edge3326 may be positioned along the elongate channel 3016 as shown. Staplebladders 3328, 3330, 3332, 3334, 3336, 3338 may also be positioned alongthe elongate channel 3016 and may be used to drive staples 3222, forexample, according to the zoned scheme described above. The staplecartridge 3037 may be placed in the elongate channel 3016 such that thecutting bladder 3322, cutting bar 3324 and cutting edge 3326 align withchannel 3049 and such that lines of staples 3222 and drivers 3370, 3372,3374, 3376, 3378, 3380 align with bladders 3328, 3330, 3332, 3334, 3336,3338.

The embodiments described above show staples 3222 resting on a staplebladder 3327, or staple bladders 3328, 3330, 3332, 3334, 3336, 3338,with various staple drivers 3220 therebetween. It will be appreciated,however, that in various non-limiting embodiments, staples may behydraulically driven utilizing other mechanisms. For example, FIGS.28-29 show a staple 3222 resting directly on a staple bladder 3504(e.g., without a staple driver). A hydraulic line 3506 may providepressurized hydraulic fluid to the bladder 3504, for example, inresponse to the actuation of the firing trigger 3028 by the clinician.When pressurized hydraulic fluid is provided to the staple bladder itmay expand transversely, as shown in FIG. 29. The transverse motion ofthe staple bladder 3504 may force the staple 3222 against staple formingpocket 3202, thereby driving the staple 3222. The assembly shown inFIGS. 28-29 may be incorporated into the end effector 3012, for example,by placing a staple bladder or bladders 3504 along the elongate channel3016. It will be appreciated that in various embodiments, each bladder3504 may drive one or a plurality of staples 3222.

FIG. 30 shows another non-limiting embodiment showing an additionalmechanism including a staple driving cylinder 3510. The cylinder 3510may include a piston 3512. The staple 3222 may rest on the piston 3512.A staple driver (not shown in FIG. 30) may or may not be present betweenthe piston 3512 and the staple 3222. A hydraulic line 3514 may providepressurized hydraulic fluid, causing the piston 3512 to extend. Inresponse, the piston 3512 may drive staple 3222 into contact with staplepocket 3202 as described above. In various embodiments, the cylinder3510 may drive one or a plurality of staples 3222. It will beappreciated that the assembly shown in FIG. 30 may be incorporated intoend effector 3012 by placing one or more cylinders 3510 along theelongate channel 3016.

FIG. 31 shows an exploded view of another non-limiting exemplaryembodiment for hydraulically driving staples according to variousembodiments of the present invention. Staples 3222 are shown resting onstaple driver 3517 which in turn rests on deployment plate 3516.Guidance rails 3518 are shown surrounding the deployment plate 3516.When provided with pressurized hydraulic fluid, bladder 3522 may expandtransversely. This may cause the deployment plate 3516 to expandtransversely along guidance rails 3518, driving staples 3222. Theguidance rails 3518 may insure that deployment plate 3516 expands in atransverse direction. In one non-limiting embodiment, staples 3222 mayrest directly on the deployment plate 3516 (e.g., without drivers 3517).It will be appreciated that the assembly shown in FIG. 31 may beincorporated into the end effector 3012 by placing one or more bladders3522, guidance rails 3518, and deployment plates 3516 along the elongatechannel 36.

FIGS. 32-34 show yet another non-limiting exemplary embodiment forhydraulically driving staples according to various embodiments. FIG. 32shows a hydraulic bladder 3524 mated to a rigid deployment plate 3526.The deployment plate 3526 may include a series of apertures 3528. Eachaperture may correspond to one or more staples. When pressurizedhydraulic fluid is applied to the bladder 3524, it may expandtransversely through the apertures 3528 in the deployment plate 3526.The portions of the bladder 3524 extending through apertures 3528 mayprovide a transverse driving force to one or more staples 3222, as shownin FIG. 34.

In various embodiments, the instrument 3010 may include an articulatingend effector 3012 as shown in FIG. 35. The end effector 3012 may pivotaway from the axis of the elongate shaft 3023 at articulation pivot3368. It can be seen that the hydraulic line bundle 3306 passes througharticulation pivot 3368 with ease.

FIG. 36 shows an embodiment of the instrument 3010 equipped with ahydraulic system 3321 according to various embodiments. A hydraulic pump3302 may generate pressurized hydraulic fluid when firing trigger 3028and/or the closure trigger 3026 is actuated. The hydraulic pump 3302 maybe any kind of device suitable for pressurizing hydraulic fluidincluding, for example, a cylinder, a bladder, etc. In variousembodiments, an additional pump (not shown) may be included, forexample, to drive the anvil 3018 in response to actuation of the closuretrigger 3026. Pressurized hydraulic fluid generated by the hydraulicpump 3302 may be provided to valve unit 3304 which may in turn providethe fluid to various bladders and/or cylinders (not shown in FIG. 36)located in the end effector 3012 via hydraulic line bundle 3306. Valveunit 3304 may include any kind of valve or valves suitable forcontrolling and directing the flow of hydraulic fluid. In variousnon-limiting embodiments, the valve unit may include electricallyactuated valves, such as, for example, piezo valves or Electro ActivePolymer (EAP) valves which may be configured in response to anelectrical signal.

One embodiment of the hydraulic system 3321 that may be employed tocontrol the end effector 3012 is depicted in schematic form in FIG. 36A.In this non-limiting embodiment, the pump 3302 is embodied as aconventional hydraulic pump assembly that includes a fluid reservoir3432. In one embodiment, the pump 3302 is powered by a battery 3434supported within the handle. In another non-limiting embodiment, thepump 3302 may be powered by the same battery 3320 powering the controlcircuit 3318 described below. It will be appreciated that the pump 3302could also be powered by other means, such as by alternating current. Inone non-limiting embodiment, the pump 3302 may be a hydraulic bladder orcylinder powered by mechanical force derived from one or more of thetriggers 3026, 3028. The pump 3302 may be fluidically coupled to thereservoir 3432 by supply line 3436 that may have a conventional checkvalve 438 therein. See FIG. 36A.

In one embodiment, a discharge line 3440 attached to the discharge port3431 of the pump 3302 is piped to a manifold 3442 that has designatedsupply lines for each bladder coupled thereto. For example, in theembodiment depicted in FIG. 36A, a supply line 3444 is coupled tobladder 3328 and has a control valve 3460 therein for controlling theflow of pressurized fluid through the line 3444 to bladder 3328. Supplyline 3446 is coupled to bladder 3330 and has a control valve 3462therein. Supply line 3448 is coupled to bladder 3332 and has a controlvalve 3464 therein. Supply line 3450 is coupled to bladder 3334 and hasa control valve 3466 therein. Supply line 3452 is coupled to bladder3336 and has a control valve 3468 therein. Supply line 3454 is coupledto bladder 3338 and has a control valve 3470 therein. Supply line 3456is coupled to cutting bladder 3322 and has control valve 3472 therein. Areturn valve 3478 is provided to permit the fluid to return from thebladders into the manifold line 3442 and through a return line 3459 thatis attached to the manifold 3442 and the reservoir 3432. As can be seenin FIG. 36A, the return line 3459 may have a return valve 3478 therein.Valves 3460, 3462, 3464, 3466, 3468, 3470, 3472, 3474, 3478 comprise avalve unit, generally designated as 3304 and described above.

The valve unit1 304 may be configured by a control circuit 3318 inresponse to input received from input buttons, such as buttons 3308,3310, 3312, 3314, and/or 3316. A battery 3320 may provide electricalpower to the control circuit 3318 and buttons 3308, 3310, 3312, 3314,3316. The control circuit 3318 may be any kind of circuit capable ofgenerating signals for configuring valve unit 3304 in response to inputfrom buttons 3308, 3310, 3312, 3314, 3316. In one non-limitingembodiment, the control circuit 3318 may include a microprocessor andother related components including Random Access Memory (RAM), Read OnlyMemory (ROM), etc. In other non-limiting embodiments, the controlcircuit 3318 may include various logical circuit elements.

The control circuit 3318 may configure the valves in response to inputbuttons 3308, 3310, 3312, 3314, 3316. In one non-limiting embodiment,each input button 3308, 3310, 3312, 3314, 3316 may correspond to aparticular surgical implement, or portion of a surgical implement,included in the end effector 3012. For example, button 3308 maycorrespond to a cutter while buttons 3310, 3312, 3314, 3316 may eachcorrespond to a zone of staples (not shown in FIG. 19). Selecting thebutton 3308, 3310, 3312, 3314, 3316 corresponding to a surgicalimplement may cause the control circuit 3318 to configure the valve unit3304 such that a hydraulic device corresponding to the function is firedwhen firing trigger 3028 is depressed, driving the correspondingsurgical implements. Multiple buttons may be selected to create firingpatterns including more than one implement. In other non-limitingembodiments, each input button 3308, 3310, 3312, 3314, 3316 mayrepresent a pre-determined firing order and/or pattern. For example,selecting a button 3308, 3310, 3312, 3314, 3316 may cause the controlcircuit 3318 to configure the valve unit 3304 such that hydraulicdevices corresponding to particular surgical implements are fired whenthe firing trigger 3028 is depressed. It will be appreciated thatvarious embodiments may have more or fewer input buttons than are shown.

In various non-limiting embodiments, control circuit 3318 may configurethe valve unit 3304 to introduce a delay to the driving of one or moresurgical implements included in the end effector 3012. For example, itmay be desirable to drive a cutting implement and then delay for apredetermined time before driving one or more zones of a staplingimplement. The delay may be accomplished according to any suitablemethod. In one non-limiting embodiment, the control circuit 3318 mayconfigure the valve unit 3304 to open a path for hydraulic fluid betweenthe hydraulic pump 3302 and a first surgical implement included in theend effector 3012. When the firing trigger 3028 is actuated, the pump3302 may generate pressurized hydraulic fluid, which drives the firstsurgical implement. The control circuit 3318 may sense when the firstsurgical implement is driven (e.g., by sensing the position of thefiring trigger 3028), for example using sensor 3405 shown in FIG. 36A.When the first surgical implement is driven, the control circuit 3318may begin a timer that counts off a predetermined delay time. At theexpiration of the predetermined delay time, the control circuit 3318 mayconfigure the valve unit 304 to provide the pressurized hydraulic fluidto a second surgical implement. Hydraulic pressure generated at theactuation of the firing trigger 3028 may be sufficient to drive thesecond surgical implement, or in various embodiments, the hydraulic pump3302 may be utilized to generate additional hydraulic pressure.

In use, the surgical stapling and severing instrument 3010 is used asdepicted in FIGS. 18, 19, and 37-43. In FIGS. 18-19, the instrument 3010is in its start position, having had an undriven, fully loaded staplecartridge 3037 snap-fitted into the distal end of the elongate channel3016. Both triggers 3026, 3028 are forward and the end effector 3012 isopen, such as would be typical after inserting the end effector 3012through a trocar or other opening into a body cavity. The instrument3010 is then manipulated by the clinician such that tissue 3248 to bestapled and severed is positioned between the staple cartridge 3037 andthe anvil 3018, as depicted in FIG. 37.

With reference to FIGS. 38-39, next, the clinician moves the closuretrigger 3026 proximally until positioned directly adjacent to the pistolgrip 3024, locking the handle portion 3020 into the closed and clampedposition. The retracted cutting edge 3326 in the end effector 3012 doesnot impede the selective opening and closing of the end effector 3012,but rather resides along the elongate channel 3016, positioned in theslot 3049 of the staple cartridge 3037. In response to the actuation ofthe closure trigger 3026, the anvil 3018 may be driven to pivot alonganvil pivot 3014.

With reference to FIGS. 40-41, after tissue clamping has occurred, theclinician moves the firing trigger 3028 proximally causing hydraulicfluid to be pressurized, for example, by hydraulic pump 3302. When theinstrument is configured to cut, the hydraulic pressure may causecutting bladder 3322 to inflate, forcing cutting bar 3324 through slot3049 and into contact with cutting edge 3326, which may sever the tissue3248. When the instrument is configured to staple, the hydraulicpressure may cause one or more of the staple bladders 3328, 3330, 3332,3334, 3336, 3338 (not shown in FIG. 41) to inflate, exerting a verticalforce on drivers 3220 which in turn drive staples 3222. With referenceto FIGS. 42-43, the clinician continues moving the firing trigger 3028until brought proximal to the closure trigger 3026 and pistol grip 3024.Thereby, all of the ends of the staples 3222 are bent over as a resultof their engagement with the anvil 3018. The process is completed byreleasing the firing trigger 3028 and by then depressing the releasebutton 3030 while simultaneously squeezing the closure trigger 3026 toopen the end effector 3012.

Although an illustrative handle portion 3020 described herein isoperated hydraulically in response to input from a clinician, it isconsistent with aspects of the invention for some or all of thefunctions of a handle portion to be powered by other means (e.g.,pneumatic, electromechanical, ultrasonic, mechanical, etc.).Furthermore, controls of each of these functions may be manuallypresented on a handle portion or be remotely controlled (e.g., wirelessremote, automated remote console, etc.).

The various non-limiting embodiments of the present invention provide ahost of advantages over prior art articulated surgical instruments. Inparticular, the various embodiments of the subject invention enable theportions of the tube member that attach a surgical implement to a handleto be inserted through a trocar or similar device and then beselectively articulated within the patient. While the variousembodiments have been described herein in connection with use with ahydraulically operated endocutter, those of ordinary skill in the artwould appreciate that the various embodiments of the subject inventioncould be employed with electrically powered endocutters and with a hostof other types of surgical implements, regardless of whether they areelectrically or hydraulically powered.

While the present invention has been illustrated by description ofseveral embodiments and while the illustrative embodiments have beendescribed in considerable detail, it is not the intention of theapplicant to restrict or in any way limit the scope of the appendedclaims to such detail. Additional advantages and modifications mayreadily appear to those skilled in the art. Accordingly, the presentinvention has been discussed in terms of endoscopic procedures andapparatus. However, use herein of terms such as “endoscopic” should notbe construed to limit the present invention to a surgical stapling andsevering instrument for use only in conjunction with an endoscopic tube(i.e., trocar). On the contrary, it is believed that the presentinvention may find use in any procedure where access is limited to asmall incision, including but not limited to laparoscopic procedures, aswell as open procedures. Moreover, the various embodiment of the presentinvention should not be limited solely to use in connection withsurgical instruments that have hydraulically powered or air poweredsurgical implements. The various embodiments of the present inventionmay also be effectively used with surgical instruments and the like thatemploy electrically driven surgical implements.

1-19. (canceled)
 20. A surgical instrument, comprising: a housing assembly; a proximal tube segment protruding distally out of said housing assembly; a distal tube segment; an articulating joint assembly pivotally coupling said distal tube segment to said proximal tube segment, said articulating joint assembly comprising: a ball member non-movably coupled to a distal end of one of said proximal and distal tube segments and rotatably received in a corresponding socket in an end of the other of said of proximal tube segment and distal tube segments; and at least one rotary driven flexible cable arranged to drivingly engage a corresponding portion of the ball member or socket for retaining a portion of said ball member in said socket and upon rotation thereof, articulate said distal tube segment relative to said proximal tube segment; and a surgical implement attached to said distal tube segment.
 21. The surgical instrument of claim 20, wherein said at least one rotary driven flexible cable is a first rotary driven cable arranged to drivingly engage a corresponding first portion of the ball member to apply an actuation motion thereto.
 22. The surgical instrument of claim 21, wherein said articulating joint assembly comprises a second rotary driven cable arranged to drivingly engage a corresponding second portion of the ball member to apply another actuation motion thereto.
 23. The surgical instrument of claim 22, wherein said first rotary driven cable is rotated by a first motor and said second rotary driven cable is rotated by a second motor.
 24. The surgical instrument of claim 20, wherein said ball member is non-movably coupled to said end of said distal tube segment and is rotatably received in a socket in said end of said proximal tube segment.
 25. The surgical instrument of claim 20, wherein said surgical implement comprises an end effector.
 26. A surgical instrument, comprising: a housing assembly; a proximal shaft segment protruding distally out of said housing assembly; a distal shaft segment; an articulating joint assembly pivotally coupling said distal tube segment to said proximal shaft segment, said articulating joint assembly comprising: a ball member non-movably coupled to a distal end of one of said proximal and distal shaft segments and rotatably received in a corresponding socket in an end of the other of said of proximal shaft segment and distal shaft segments; and at least one rotary driven flexible cable arranged to drivingly engage a corresponding portion of the ball member or socket for retaining a portion of said ball member in said socket and upon rotation thereof, articulate said distal shaft segment relative to said proximal shaft segment; and a surgical implement attached to said distal shaft segment.
 27. The surgical instrument of claim 26, wherein said at least one rotary driven flexible cable is a first rotary driven cable arranged to drivingly engage a corresponding first portion of the ball member to apply an actuation motion thereto.
 28. The surgical instrument of claim 27, wherein said articulating joint assembly comprises a second rotary driven cable arranged to drivingly engage a corresponding second portion of the ball member to apply another actuation motion thereto.
 29. The surgical instrument of claim 28, wherein said first rotary driven cable is rotated by a first motor and said second rotary driven cable is rotated by a second motor.
 30. The surgical instrument of claim 26, wherein said ball member is non-movably coupled to said end of said distal tube segment and is rotatably received in a socket in said end of said proximal tube segment.
 31. The surgical instrument of claim 26, wherein said surgical implement comprises an end effector. 